Medicare Secondary Payer Intake: Provider Questionnaire and Billing Guide

This guide summarizes CMS operational guidance available through October 8, 2026. It addresses Original Medicare provider intake and claim preparation at a general level. It does not decide payer priority for a particular patient, replace current CMS manuals or MAC instructions, or provide individualized legal advice.

MSP intake workflow at a glance

1. Screen for more than another insurance card

CMS states that providers must determine whether Medicare is primary or secondary. For institutional providers, CMS recommends obtaining billing information before services and using the CMS questionnaire or questions that collect similar information. Effective screening connects coverage to the reason Medicare may pay second rather than merely recording the name of another plan.

• Is the beneficiary or spouse actively employed, and what is the employer group size?
• Is coverage related to disability and current employment of the beneficiary or a family member?
• Is the patient entitled to Medicare because of end-stage renal disease, and where is the coordination period?
• Was the service caused by an automobile accident, premises event, product event, or other possible liability claim?
• Is no-fault, medical-payments, or workers' compensation coverage involved?
• Has an insurer accepted ongoing responsibility for medicals, denied responsibility, settled, or exhausted benefits?
• Do the insurer name, policy, claim number, effective dates, and adjuster information match the event and service date?

2. Use a dated, service-specific questionnaire

The questionnaire should identify who supplied each answer, when it was obtained, and which dates of service it supports. Carry-forward answers should be reconfirmed when the patient's employment, spouse coverage, accident status, ESRD coordination period, or claim status may have changed. Preserve both positive and negative responses; CMS guidance treats negative answers as part of the MSP record.

3. Bill the primary payer properly and timely

CMS instructs providers to file proper and timely claims with the primary payer. A Medicare claim should not be used to avoid a primary payer's ordinary filing, authorization, documentation, or appeal requirements. Preserve the primary claim, acceptance report, EOB, payment, denial, and any requested information because the later Medicare claim must reflect what actually occurred.

1. Verify the exact primary policy and claim for the service date.
2. Submit the claim with payer-specific identifiers and required support.
3. Track initial receipt, rejection, information requests, adjudication, and appeal activity.
4. Reconcile payments, contractual adjustments, patient responsibility, and denials by line.
5. Use the primary EOB and claim data to prepare the Medicare secondary claim.
6. Escalate payer-priority conflicts without changing the historical intake record.

4. Match Medicare claim data to the evidence

Institutional and professional MSP claims use different claim fields and transaction segments. The Medicare claim should carry the applicable payer, insurance type, accident or employment information, primary adjudication, and adjustment data required by CMS and the MAC. A contradictory date, insurance type, or payment amount can cause a denial or misroute the claim even when the underlying service is covered.

5. Understand conditional payment without promising it

Medicare may make a conditional payment in certain liability, no-fault, or workers' compensation situations when prompt primary payment is not expected, subject to CMS rules and recovery rights. Conditional payment is not an intake shortcut and is not guaranteed merely because a bill is unpaid. The record should show the primary payer, claim status, attempts to obtain payment, and why the Medicare billing pathway used is permitted.

When Medicare pays conditionally, federal recovery processes may later apply. Provider teams should avoid telling a patient that Medicare is finally responsible or that a liability settlement has no Medicare consequences. Separate provider billing work from beneficiary, insurer, attorney, and CMS recovery responsibilities.

6. Resolve conflicting MSP information

• Compare the questionnaire with Medicare eligibility and the Common Working File information available through authorized channels.
• Identify the exact conflict: payer, insurance type, effective date, termination date, accident date, or claim status.
• Collect objective support rather than relying only on a verbal statement.
• Follow current MAC or Benefits Coordination & Recovery Center instructions for corrections or development.
• Submit corrected claim data only after the underlying coordination record is addressed.
• Document every contact, reference number, submission, and response.

7. Retain the MSP record

The CMS MLN booklet instructs providers to keep completed MSP questionnaires and other MSP information for 10 years after the service date, including positive and negative responses. Records may be maintained in permitted formats, but they must remain accessible and connected to the relevant encounter. Apply organizational retention, privacy, and security controls in addition to the CMS requirement.

Provider quality-control checklist

• Current Medicare entitlement and service date confirmed.
• Employment, spouse, disability, and ESRD questions completed when applicable.
• Accident, liability, no-fault, and workers compensation screening completed.
• Other payer policy, claim, effective dates, and status verified.
• Questionnaire source, date, and staff member documented.
• Primary claim and adjudication evidence preserved.
• Medicare claim data reconciled to the questionnaire and EOB.
• Conditional-payment treatment supported rather than assumed.
• Conflicts routed through the current MAC/BCRC process.
• Positive and negative MSP responses retained for the required period.

Related Millennova Legal resources

See Millennova Legal's patient and client intake services, Medicare ABN documentation guide, Original Medicare appeals guide, and HIPAA reimbursement-documentation guide.

Primary CMS sources